People who abuse drugs– such as opiates, amphetamines or cocaine– often experience changes in their mood. At times, these changes may be so severe that they are disturbing to the person experiencing them, and could be part of a depressive illness. Depression and drug abuse are both common and can occur together purely by chance as individual problems. More often, however, there is an interaction between the two and this can take several forms. A person may be suffering from depressive symptoms and take drugs in the hope of gaining relieving these symptoms, or depressive symptoms may develop as a result of taking drugs or from withdrawal symptoms when drug-taking stops.
A person may also take drugs to ‘escape’ from a problem during a particularly stressful time in their life. Sometimes this may even include prescription drug abuse. This stress may also be the trigger for an episode of depression. Additionally, heavy drug use can lead to major financial problems, difficulties with relationships or trouble with the law. A person suffering from chemical dependency is likely to have more of these pressures, which increases the likelihood of depression. In extreme circumstances, people who are depressed may use drugs in an attempt to end their life. Drug use is especially common in other psychiatric illnesses (such as post-traumatic stress disorder or some anxiety disorders and phobias) that can also have depressive symptoms, even if the main problem is not depression itself.
Why do recreational drugs have these effects when people take them to feel good? There are certain chemicals in the brain (called neurotransmitters) that are key to the way we feel – in other words they control our emotions. It’s the levels of these chemicals that are altered in depression. Recreational drugs also affect these chemicals. This is why drugs alter the way we feel. Different neurotransmitters are affected by different drugs: dopamine is affected by cocaine, amphetamines and ecstasy, while serotonin (or 5-HT) is affected by ecstasy and LSD and noradrenaline (Norepinephrine) is affected by amphetamines and opiates (heroin, morphine etc). It’s primarily these three chemicals (dopamine, serotonin and noradrenaline) on which antidepressant medicines work.
What does all this mean for someone who feels depressed and who is using drugs? It means that to be able to help them effectively, doctors have to sort out what role the drugs play in the depression. If the feelings of depression are simply part of the drug addiction withdrawal and are temporary, it is unlikely that antidepressant treatment will be of benefit; antidepressants take an absolute minimum of two or three weeks to start working. The best help in this case is to try to help the person to get their drug use under control or stopped. Taking drugs and the withdrawal process can both produce depressive symptoms, so it is very difficult to know exactly what is going on, even if it seems that the depression led to drug taking in the first place. Additionally, a medical detox may be necessary. As a result, it’s vital to sort out the drug problem – so it’s possible to judge whether antidepressants or other treatments for depression are needed. This doesn’t mean it’s impossible to treat the depression when someone is still taking drugs, but it does make it more difficult.
What should I do if I have this problem? First, try to keep as much control as possible over your chemical dependency so things don’t get worse, and most importantly, seek help in the form of drug or alcohol rehab. You may need treatment for the drug problem, the low mood or both, which is known as dual diagnosis. A professional at a drug rehab center will be able to advise you and help you make the necessary arrangements to get help. It is important that you are honest about your drug use with any doctor, nurse or other professional you are seeing. Otherwise they will find it very difficult to work out how best to help you. Help from social services may be a good thing to ask for if you are running into problems with debts, housing, etc, as these can only make things worse if they don’t get sorted out. Remember, such problems may have contributed to your difficulties in the first place.
If you think your friend or relative may have a problem with chemical dependency, you may wish to suggest to them that you have noticed there is something wrong. Ask them if they have considered asking for help from any of the sources mentioned above. It may be difficult if the person doesn’t want you to know they have a drug problem: be diplomatic and encourage them to see someone about the depression. Leave the rest of the working out to the professional they see.